Use of Project ECHO to promote evidence based care for justice involved adults with opioid use disorder

Abstract

Background: People with opioid use disorders (OUDs) are at heightened risk for involvement with the criminal justice system. Growing evidence supports the safety and effectiveness of providing empirically supported treatments for OUD, such as medications for OUD (M-OUD), to people with criminal justice involvement including during incarceration or upon reentry into the community. However, several barriers limit availability and accessibility of these treatment options for people with OUDs, including a shortage of healthcare and justice professionals trained in how to implement them. This study evaluated a novel education program, the Indiana Jail OUD Treatment ECHO, designed to disseminate specialty knowledge and improve attitudes about providing M-OUD in justice settings. Methods: Through didactic presentations and case-based learning (10 bimonthly, 90-min sessions), a multidisciplinary panel of specialists interacted with a diverse group of community-based participants from healthcare, criminal justice, law enforcement, and related fields. Participants completed standardized surveys about OUD knowledge and attitudes about delivering M-OUD in correctional settings. Thematic analysis of case presentations was conducted. Results: Among 43 participants with pre- and post-series evaluation data, knowledge about OUD increased and treatment was viewed as more practical after the ECHO series compared to before. Cases presented during the program typically involved complicated medical and psychiatric comorbidities, and recommendations addressed several themes including harm reduction, post-release supports, and integration of M-OUD and non-pharmacological interventions. Conclusions: Evaluation of future iterations of this innovative program should address attendance and provider behavior change as well as patient and community outcomes associated with ECHO participation.

Keywords:

• Opioid use disorder
• criminal justice
• Project ECHO
• continuing medical education
• medication assisted treatment (MAT)
• medication for opioid use disorder (M-OUD)

Acknowledgements

The authors wish to thank Kristen Kelley, the Coordinator for the Indiana OUD ECHO program and Brandon George, Director of Indiana Addiction Issues Coalition, who facilitated this series and contributed greatly to its development. We also wish to acknowledge the contributions of the hub team panelists and community-based participants for this program.

Author contributions

ZA, LH, and JA conceived of the Indiana OUD ECHO program. ZA and LH managed the operations of the Indiana OUD program. JA led evaluation, including data collection, management, and analysis for this project, with assistance from TJ. ZA, JA, CP, and LB took the lead in writing this manuscript. ZA and MG reviewed and summarized case presentations. All authors, ZA, JA, CP, LB, MA, TJ, MG, CO, and LH, provided critical feedback and contributed to the writing of the manuscript.

Disclosure statement

None of the authors report a conflict of interest.

Notes

1 The program was developed, launched, and marketed as the Jail MAT ECHO, in reference to medication assisted treatment. Current iterations of the program use the more up-to-date and accurate term, M-OUD, in reference to medications for OUD or to OUD Treatment more generally.

Additional information

Funding

This work was supported by the Indiana Family and Social Services Administration Division of Mental Health and Addiction. The supporting organization had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.